Healthcare Provider Details

I. General information

NPI: 1902177553
Provider Name (Legal Business Name): MALORIE BOTARDO SWEENEY MS, RD, CEDS-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALORIE BOTARDO MESSER

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 ORINDA CT
THOUSAND OAKS CA
91362-1468
US

IV. Provider business mailing address

1862 ORINDA CT
THOUSAND OAKS CA
91362-1468
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-2038
  • Fax:
Mailing address:
  • Phone: 786-514-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86007012
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: